MOST POPULAR ARTICLES OF THE MONTH

Editor's Note

If you are still stuck on the “metformin to start with and max out the dose” diabetes treatment algorithm, then you’d better take a look at this week’s homerun slides. Considering there are 11 distinct pathways to developing diabetes, it doesn’t make any sense that all our patients would only have some sort of excess glucagon release problem. Dr Stanley Schwartz discusses how different causes require different medications, and how you can choose the best one. He also helps you choose based on the patient’s comorbidities.

If you take a chance and click on the link you may change your prescribing habits forever.

Dave JoffeEditor-in-chief

DISASTERS AVERTED — Near Miss Case Studies

Female, 32 years of age, well aware of the fact she had type 1 diabetes, was suicidal, who reported she chose to stop taking her insulin a few days earlier. Was taken to the police station on a warrant (unknown reason), who took her to the ED due to her report of suicidal ideation. She was found to be hyperglycemic at that time, but did not say she had type 1. Acetone was negative. Given 5 units regular insulin and sent back with police. She then started complaining of not feeling well, taken back to ED, no treatment and sent back with police. The next morning, complained of nausea, vomiting, and abdominal pain.

CLINICAL GEMS — The Best from Diabetes Texts

Beta-Cell response to intravenous glucose: Although in normal living conditions beta cells are stimulated by hyperglycemia that follows glucose ingestion, the study of the response to intravenous glucose is of fundamental importance for understanding the physiology of beta cells. Several tests have been developed for this purpose and this section describes the most relevant and the characteristics of insulin secretion that they reveal.

MOST POPULAR ARTICLES OF THE MONTH

When it comes to metformin, when appropriate, I recommend the extended release version. Last week my patient, female, 56 years of age, type 2 diabetes, visited. A1C was elevated, and she gained 5 pounds. She had been on metformin ER for the last 6 months and doing well. She said she recently noticed a bean-looking/pill-looking thing in her stools that seemed to be related to her metformin.

MOST POPULAR ARTICLES OF THE MONTH

If you are still stuck on the “metformin to start with and max out the dose” diabetes treatment algorithm, then you’d better take a look at this week’s homerun slides. Considering there are 11 distinct pathways to developing diabetes, it doesn’t make any sense that all our patients would only have some sort of excess glucagon release problem. Dr Stanley Schwartz discusses how different causes require different medications, and how you can choose the best one. He also helps you choose based on the patient’s comorbidities.

If you take a chance and click on the link you may change your prescribing habits forever.

Female, 32 years of age, well aware of the fact she had type 1 diabetes, was suicidal, who reported she chose to stop taking her insulin a few days earlier. Was taken to the police station on a warrant (unknown reason), who took her to the ED due to her report of suicidal ideation. She was found to be hyperglycemic at that time, but did not say she had type 1. Acetone was negative. Given 5 units regular insulin and sent back with police. She then started complaining of not feeling well, taken back to ED, no treatment and sent back with police. The next morning, complained of nausea, vomiting, and abdominal pain.

Beta-Cell response to intravenous glucose: Although in normal living conditions beta cells are stimulated by hyperglycemia that follows glucose ingestion, the study of the response to intravenous glucose is of fundamental importance for understanding the physiology of beta cells. Several tests have been developed for this purpose and this section describes the most relevant and the characteristics of insulin secretion that they reveal.

When it comes to metformin, when appropriate, I recommend the extended release version. Last week my patient, female, 56 years of age, type 2 diabetes, visited. A1C was elevated, and she gained 5 pounds. She had been on metformin ER for the last 6 months and doing well. She said she recently noticed a bean-looking/pill-looking thing in her stools that seemed to be related to her metformin.